Check with the intended audience first! Content validation as a method for inclusive research for primary care engagement in rural Appalachia

INTRODUCTION: To date, referral practices based on social determinants of health (SDOH) among primary care providers (PCPs) and clinic staff in rural regions, including Appalachian North Carolina (NC), are not well understood. 

PURPOSE: This study aims to develop and content validate a primary care engagement (PCE) survey to assess (1) engagement and burnout; (2) referral practices; and (3) self-efficacy and confidence in making referrals based on SDOH among PCPs and clinic staff in Appalachian NC. 

METHODS: Using the Social-Ecological Model as a theoretical framework, researchers developed a 37-item PCE survey. Content validation was completed by a panel of experts recruited from a convenience sample of faculty at a local university and PCPs and clinic staff practicing in Appalachian NC. Participants rated the degree of relevance of survey questions on a four-point Likert scale and provided additional feedback about the wording/appropriateness for the intended audience. Content validity index (CVI) scores were calculated for each question by averaging the degree of relevance ratings. 

RESULTS: Ten participants completed the study between August and November 2022 (nurse practitioners, academic researchers, clinical support staff/quality improvement associates, administrative staff supervisor, administrator/practice manager). CVI scores for each item ranged from 3.43 to 4.0. Comments regarding potential improvements were primarily focused on small edits, including grammar-related changes and opportunities for clarity and inclusivity. 

IMPLICATIONS: High CVI ratings for all survey items indicate the overall approach/survey aim resonates with local clinicians and individuals with expertise in SDOH. This study and the final survey lay the foundation for collaborative, collective-impact initiatives that are directly informed by the survey findings.